A Public Health Approach to Illegal Drugs
Presentation given by Mark Haden - Addiction Services, Education Series
Email:
Phone: (604) 267-3975
Historians may date the beginning of the Harm Reduction movement from June of 1998. This is when the Secretary General of the United Nations opened a letter with 47 pages of signatures including 11 Nobel Prize winners, 7 heads of state, BC’s Provincial Public Health Officer, and 13 Canadian Members of Parliament. The letter stated:
We believe that the global war on drugs is now causing more harm than drug abuse itself…every decade the United Nations adopts new international conventions, focused largely on criminalization and punishment. Every year, governments enact more punitive and costly drug control measures. Every day, politicians endorse harsher, new drug war strategies. What’s the result? The illegal drug industry has empowered organized criminals, corrupted governments at all levels, eroded internal security, stimulated violence and distorted both economic markets and moral values. These are the consequences not of drug use per se but of decades of failed and futile drug war policies. Scarce resources, better expended on health, education, and economic development are squandered on ever more expensive interdiction methods. Realistic proposals to reduce drug related crime, disease and death are abandoned in favour of rhetorical proposals to create drug free societies.
This is a reflection of a global change in how addiction is understood and treated around the world.
The goal of this talk is to examine this change both globally and in Vancouver. It is important to examine other countries as we can learn from their successes and mistakes. The policies of the USA have significant impact on how we structure our laws and we should try to avoid their errors.
Changing the way we deal with drugs. Our current approach is ineffective, expensive, and harmful to individuals, families and society. It also hurts services, the economy and can damage political processes.
The war on drugs
What is the effect of the war on drugs in the USA and Canada?
Social consequences of the “war on drugs”
· Propaganda - difficult to get accurate information.
· War restricts personal freedom - War Measures Act.
· Canadian citizens become enemies (civil war?).
· Promotes violence (police violence [1],[2],[3] gang violence. [4],[5],[6])
· Promotes crime.
· 60-80% of B&E’s in Vancouver are to support habit.
· $2000 worth of stolen goods + $200 cash to buy $20 worth of drugs.
· In the first year of Prohibition crime leaped 24% in USA major cities.[7]
· Vancouver had 3 pawn shops in the Downtown Eastside in 1980's now there are 45.
· The Criminal Intelligence Service Canada report states that “Illict drugs continue to be the major source of criminal profit for organized crime groups.”[8]
· The CCSA report observes: “alcohol dependent federal inmates were much more likely to have committed a violent crime than were drug-dependent inmates, while drug dependent inmates were more likely to have committed a gainful crime.” [9]
· Restricts religious practices. It took many years of litigation before the US allowed the Native American Church to use peyote legally, in accordance with their historical traditions.
· Racist (The USA has the highest incarceration rate in the world with 468 of every 100,000 being in jail. The next two countries South Africa = 333 and Soviet Union = 268. In the USA Caucasians = 197 and black Americans = 1,534. (In Texas and Oklahoma it exceeds 2000 per 100,000). Canada is 143 per 100,000.[10],[11] One in four black man in the USA in either in jail, on probation or parole. [12]
· Prohibits beneficial use of some drugs (i.e. hemp paper, clothes, medicine).
· Biases research and data collection.[13] “Out of the box” research is not supported. This prevents our exploration of possible beneficial uses of currently illegal drugs and does not allow us to fully understand drug using behavior in our society. We have difficulty distinguishing between drug use, abuse and addiction. Research is also misinterpreted.[14]
· Observed wide spread violation of the law, weakens general respect for law and order. 72% of all drug offences are for marijuana. The majority of these 47,000 offences (in 1996) were for simple possession.[15] Erickson’s study showed the possession charges did not result in decreased drug use but did result in a decreased respect for the law[16] Historically drug laws have been based on racism.
· Goes against free and democratic society.
Individual consequences of the “war on drugs”
· Seizure of property in USA (profits go to police departments). Suspicion is enough to enact forfeiture. 80% never get charged with a crime they just loose their possessions. [17] Police Departments have requested more asset seizures from their officers due to low departmental budgets.[18],[19]
· Criminal acts are encouraged. As enforcement “pressure” goes up, drug smugglers and large volume dealers insulate themselves by increasing the “organizational levels” between them and the buyer. The larger the organization, the more people are drawn into the criminal lifestyle.[20]
· Goes against concept of personal responsibility.
· Promotes intolerance of others - discrimination/marginalization /disenfranchising.
· Isolates people who could be more connected to others and services.
Health consequences of the “war on drugs”
· Lack of pure drugs and clean needles are a health risk.
· May lead to punitive pain management practices. [21]
· Increases the spread of blood born diseases. IV drug users do not inject safely if they are not in a “health service” context.
· Drug users die. No over-dose death has occurred in a supervised injection site.
· Arial crop spraying in source countries damages environment and innocent people.[22] (“Plan Columbia” is the USA spraying coca plants)
· Produces more concentrated (more addictive) drugs which are easier to smuggle.
Family consequences of the “war on drugs”
· Children and young teens become criminalized. In the USA the manditory minimum sentences apply to individuals age 18 and older. This results in adults finding children to deal and transport drugs.[23]
· Children (and families) are victimized. In Vancouver children are apprehended for a few days during a “grow operation” bust.
· Family members become enemies.
Consequences of the “war on drugs” on police and health services
· Takes away police time from pursuing “real” criminals. Drug investigations are time and resource consuming. Our scarce tax dollars would be better spent dealing with crimes of force, fraud and public safety.
· Is abusive to the police. To require the police to treat addicts as criminals creates job stress. Can be a corrupting force within this service, which tarnishes their profession. [24],[25],[26],[27]
· Makes it difficult to provide health services (supervised sites, drugs on Rx).
· Enforcement “pressure” can reduce attendance at services (i.e. needle exchange[28])
Economic consequences of the “war on drugs”
· Escalates price of drugs (so black market is well paid but price is not high enough to make unavailable).
· Very costly (police, courts, jails).
· Average jail time in U.S.A.: manslaughter = 12 months: drugs = 60 months. (More than kidnapping, robbery, arson, extortion, assault).
· It costs more to send a man to jail than it does to send him to college (room, board, tuition and transportation). Prison bed cost $50,000 to $70,000 to build and $20,000 to $35,000 per year to fill. The per pupil cost at a well equipped American school is $15,000.[29]
· Canada spends $1 Billion per year to address illicit drugs[30]. Canada spends $95 on enforcement for every $5 it spends on health services in response to the problem of illegal drugs. [31] (Federal perspective)
· Black market does not pay taxes. Various estimates for the black market range from $600 billion [32] to $100 billion.[33] The most commonly estimated size is $400 billion.[34],[35] Canadian Federal Government collected $121 billion in taxes last year. Vancouver drug trade estimated to be $400,000 to $800,000 per day or approx 200 million per year (Werner Schneider, Illegal Drug Use conference Sept 2000).
· Drug money destabilizes world markets.[36],[37] the Economist has recommended drug legalization for this reason.[38]
· Legitimate businesses are “scared away” from some neighborhoods.
· There are direct and indirect costs from crime. The direct costs are the emotional and financial burden on the victims, and the societal costs of maintaining the justice system. The indirect costs are the increases in retail prices (to factor in shoplifting) and increased car and house insurance prices.
· The value of real-estate near open drug scenes is devalued.
Political consequences of the “war on drugs”
· People become suspicious of government. Many books have been written suggesting various conspiracy theories regarding the government’s involvement in drug dealing.[39],[40],[41]
· The drug war supports terrorism. Terrorists rely on “hidden” laundered money to operate which often comes from drug dollars.
· Drug money destabilizes governments.[42],[43],[44],[45],[46] For example, Pablo Escobar killed many government officials in Columbia.[47] There are more guns in the drug armies in Burma than the government army[48]. Smugglers who have money and need protection join forces with guerilla armies who need money and have weapons. Joining forces = government instability [49].
· The assumption of the war on drugs is that drug addicts (or drug users) are bad and need punishment and segregation from society (prisons).[50]
Do we have the “war on drugs” in Canada? Two reports have explored this question. Eric Single concludes Canadians spend $4. on enforcement for every $1. that is spent on treatment.[51] The Federal Auditor General concludes that Canada spends $95.00 on enforcement for every $5.00 which are spent on treatment and prevention. [52]
A good indicator that the War on Drugs is failing comes from a group of 50 American Federal Judges who, in protest to unfair mandatory minimum sentencing, announced that they would no longer try drug cases.[53]
Does criminalization stop drug use?
Being illegal does not mean they are not available:
· Easy to get delivered.
· Exist in all schools.
· Teens believe that drugs are easier to get than alcohol. [54]
· Bruce Alexander makes it clear that historically the law does not stop use most of the time.[55]
· Throughout the war on drugs drug price has gone down and purity has gone up. [56],[57],[58]
· Study on Canada’s largest heroin seizure (100kg) showed no impact on use levels, and no impact on other public health indicators (OD deaths, frequency of injecting, etc).[59]
· Drug related emergencies have gone up throughout the war on drugs.[60]
· Drug use is common in jail
· “We cannot arrest our way out of the problem”: Kash Heed.[61]
· “the available scientific literature establishes no relationship between severity of legislation and life prevalence of cannabis use”: Senate Special Committee on Illegal Drugs: Cannabis. [62]
· “there have been growing acknowledgements by Canadians and parliamentarians that there are limits on the ability of law enforcement to reduce the supply of drugs”. [63]: Auditor General of Canada
Does decriminalization increase drug use?
If criminalization does not reduce drug consumption does decriminalization increase drug use? Eleven states decriminalized marijuana during the 60's and 70's and this did not increase consumption.[64],[65],[66] Amsterdam where marijuana is legal has half the consumption of the USA where it is illegal.[67],[68]
Historical polarized debate does not offer solutions.
The debate in our society for the last 20 years has been legalization vs criminalization. The debate has not progressed as neither of these two polar opposites offers effective solutions.
If criminalization does not work what is the effect of legalization and promotion?
Alcohol \ tobacco model does not work (1&2 drug killers in our society).
We can’t ignore the problem.
Needle park as an attempt to not criminalize and not actively deal with the problem.
Zurich - Switzerland
No penalty for use in one area
1000 user daily
1986-1994 closed after open for 8 years
Increased violence, HIV, robberies, gang violence, drug deaths
Black market thrived.[69]
What is Harm Reduction?
Harm reduction appears to be the best solution:
Harm reduction asks the Question: How do you reduce the harm to individuals and society given the fact that some individuals will use drugs.
We currently use harm reduction theory for many issues:
Cars kill people: safe driving courses / seat belts / stop signs / speed limits are all harm reduction strategies.
Eric Single (1999) examines three definitions of harm reduction:
1) That which applies to individuals who continue to use drugs.
2) All inclusive definition which includes all Addiction Services as all programs want to reduce harm.
3) Those programs which can be demonstrated empirically to reduce harm to users and the larger society (including marginalization of users, social and personal costs).[70]
Harm reduction theory recognizes that there is a continuum of drug use from problematic to
non-problematic.[71]
Harm Reduction is not the same as the criminalization, legalization debate.
Not just about legalization of drugs - it’s a whole philosophy/set of values.
Not a Trojan horse for legalization.
Drug addicts are seen in the larger social context of poverty, family abuse, social isolation, marginalization, and not just criminals in need of punishment.
Using Harm Reduction strategies does not mean we approve of the behaviour:
For young teenagers who are sexually active: while we disapprove, we also engage, provide services and give accurate information (and prescriptions). We understand the strict abstinence based messages alone would result is more pregnancies.
We do not criminalize or jail women who drink during pregnancy. We agree that this is a significant social problem. If we criminalized women who used alcohol during pregnancy they would become isolated and therefore probably drink more, and our collective social damage would go up. Instead we use the public health tools of, education, increasing support, understanding the social determinents of health, etc, which for this social problem are the most effective. Not criminalizing a behaviour does not mean we support the action.
Using harm reduction strategies for drug problems does not mean the society condones drug use.
As sociologist Craig Reinarman notes, our policies attack the symptoms but do little to address the underlying problems. "Drugs are richly functional scapegoats," Reinarman writes. "They provide elites with fig leafs to place over the unsightly social ills that are endemic to the social system over which they preside. They provide the public with a restricted aperture of attribution in which only the chemical bogey man or lone deviant come into view and the social causes of a cornucopia of complex problems are out of the picture." [72]